Surgical laparoscopic robots are currently used to maneuver instruments with high precision allowing micro-scale tasks otherwise not possible. Despite these successes, the benefits of laparoscopy are generally limited to less complex procedures because the surgeon loses the ability to manipulate tissue and visualize the surgical field from multiple angles.
From the point of view of a surgeon, minimally invasive surgery is minimal access surgery (Tendick, et al. (1998) IEEE/ASME Trans. Mechatron. 3(1):34-42). Reduced access reduces dexterity, limits perception, increases strain and the likelihood of error, and lengthens procedure times (Falcone & Goldberg (2003) Clin. Obstet. Gynecol. 46(1): 37-43; Li, et al. (2000) Comp. Aid. Surg. 5:326-332; Tendick, et al. (1998) IEEE/ASME Trans. Mechatron. 3(1):34-42). The operative field is visualized through an electronic interface, and tissue manipulation is performed with long instruments that impose severe ergonomic limitations (Li, et al. (2000) Comp. Aid. Surg. 5:326-332). The long, rigid instruments and cameras typically used in laparoscopic surgery are constrained to only four degrees of freedom (three rotations and in-out translation) through the entry incision. This prevents orienting the tool tips arbitrarily. Dexterity is significantly reduced because of the lost degrees of freedom and because of motion reversal due to the fulcrum effect at the entry point (Cavusoglu, et al. (2003) Indust. Robot: Intl. J. 30(1): 22-29).
Vision limitations are significant (Tendick, et al. (1996) In: Computer Integrated Surgery: Technology and Clinical Applications; Treat (1996) In: Computer Integrated Surgery: Technology and Clinical Applications) because the current field of view cannot encompass the frequent changes of instruments as they pass through the abdominal cavity. This has led to accidental injury to organs and vascular structures (Southern Surgeons Club (1991) N. Engl. J. Med. 324:1073-1078; Wolfe, et al (1991) Arch. Surg. 126:1192-1998). Additional viewpoints showing the entire body cavity have been suggested as being helpful (Schippers & Schumpelick (1996) In: Computer Integrated Surgery: Technology and Clinical Applications). Mobility limitations are significant and lead to patient complications because it is not possible for the surgeon to compensate for the lost degrees of freedom during complex tasks (e.g., suturing) (Tendick, et al. (1996) supra). These limitations have impeded the use of laparoscopy.
Dexterity constraints also prevent the optimal placement of the camera used to visualize the abdominal cavity while preparing for and performing surgery. Obstructed or incomplete visual feedback can contribute to a variety of complications. Common complications while inserting access ports and during the surgical procedure itself include aortic and vascular injury, pneumothorax, and bowel perforations (Kazemier, et al. (1998) J. Am. Coll. Surg. 186(5):604-5; Leggett, et al. (2002) Surg. Endoscopy 16(2):362; Munro (2002) Curr. Opin. Obstet. Gynecol. 14(4):365-74; Orlando, et al. (2003) J. Laparoendo. Adv. Surg. Techn. 13(3):181-184). The challenges associated with performing laparoscopic procedures are graphically illustrated by the fact that under identical experimental conditions, suturing a square knot with laparoscopic tools takes almost twice as long as with hand tools in open surgery (Tendick, et al. (1993) Presence 2:66-81). Until visual feedback and dexterity improve, the enormous potential for minimally invasive surgery to replace many open conventional procedures will not be fully realized.
Surgical imaging devices exist, but do not provide the range of vision needed to provide adequate visual feedback to improve dexterity. A miniature disposable imaging capsule has been developed. See U.S. patent application Ser. No. 09/759,398. The capsule is swallowed by the patient and, with the natural movement of bowel, it passively moves through the gastrointestinal tract, and is passed naturally out of the body. The capsule transmits information (such as imaging information) to a receiver worn by the patient, which is later processed on a computer. The capsule consists of lens, illuminating LEDs, imager, battery, transmitter, and antenna. However, this device was designed for use in colonoscopy and would not function well in an open abdominal cavity during laparoscopic surgery.
U.S. patent application Ser. No. 10/672,274 teaches a device for imaging anatomical structures in a videoendoscopic surgery training system. The device comprises a digital video camera disposed within a practice volume; and a support structure comprising an elongate member having a proximal end disposed outside of the practice volume, and a distal end disposed inside the practice volume, the digital video camera being coupled with the distal end of the elongate member. The support structure comprises a bracket configured to enable the elongate member to pan and tilt. A light source is also disclosed to illuminate the anatomical structure.
Needed in the art is an imaging device for enhanced surgical field visualization from multiple angles within an open space such as the abdominal cavity. The present invention meets this need by providing a camera robot, the whole of which can be placed within the open abdominal cavity, to supply visual feedback to a surgeon during surgical procedures without the need for additional incisions to accommodate the imaging system.